Use of compounds with thrombopoietic activity to promote bone growth and healing

ABSTRACT

TPO was used to promote the growth of bone in both rats and in mice. Gaps in both mouse and in rat bones were treated with a scaffold sized to fit the gap. Scaffolds that included TPO promoted better outcomes than scaffolds that included BMP-2 or scaffolds that did not include either TPO or BMP-2. These data indicate that compounds that exhibit thrombopoietic activity such a recombinant TPO can be used to promote bone growth and healing in mammals.

PRIORITY CLAIM

This application claims the benefit of U.S. provisional patentapplication No. 61/351,208 filed on Jun. 3, 2010, which is incorporatedherein by reference in its entirety.

FIELD OF THE INVENTION

Aspects of the invention relate to promoting bone growth in mammals bytreating bone defects, especially breaks and/or gaps with compounds thatexhibit thrombopoietic activity.

BACKGROUND

Each year, approximately 6 million fractures occur in the United States.These fractures result in over 9 million physician visits and a loss ofmore than 36 million work days [1]. Fractures resulting in segmentaldefects of the long bones are particularly difficult to manage, oftenrequiring multiple surgeries in an attempt to achieve adequate union andfunction [2].

There are many causes of segmental defects. They may be the result ofmany causes, including tumor resection, treatment of infection, failureof arthoplasty—but the most common cause is from trauma, particularlymotor vehicle associated trauma. High energy, open fractures may resultin direct immediate bone loss or may require debridement ofdevascularized contaminated bone. This is a common, yet challenging,problem for orthopaedic traumatologists and their patients. Theincidence of severe lower extremity trauma in civilian life is certainlyincreasing due to the epidemic of road traffic accidents around theworld. In the US alone, over a quarter million admissions annually aredue to lower extremity injuries, and it is estimated that more than halfare the result of high energy mechanisms [3].

The recent military conflicts around the world have also increased theneed to address high energy or blast injuries which often involve bonetrauma and tissue loss. Over 75% of modern war injuries involve theextremities, predominantly caused by fragments from explosive devices,which commonly cause open fractures with contaminated wounds and tissueloss [4]. These examples illustrate that there are needs in many areasof orthopaedics to improve bone healing.

Achieving bone union can be difficult in all aspects of orthopaedics,including spine, trauma, and upper extremity surgery. Failure to achievebone union results in multiple additional surgeries, significantmorbidity, and ultimately can lead to loss of extremity function oramputation for the patient. In cases of fracture nonunion alone, some450,000 grafting procedures are performed yearly [5]. Many additionalbone grafting procedures are required for spinal fusion. The goldstandard for grafting to achieve bone union/fusion is the use of donorbone (called autograft) from the patient's hip. This often leaves apatient with a very painful donor site, which may not resolve. There isa need then for biologic enhancements for bone healing that do notrequire the harvesting of a patient's iliac crest hip bone trauma ortumour. Some aspects of the invention address this need.

SUMMARY

Some embodiments of the invention include methods for treating bonecomprising the steps of: administering a compound that exhibitsthrombopoietic activity in order to promote the healing of a defect,disease or injury in at least one bone. In some embodiments, thecompound having thrombopoietic activity is selected from the groupconsisting of thrombopoietin (TPO). including recombinant forms of TPO,compounds such as romiplostim and megakaryocyte growth and developmentfactor (MGDF). In some embodiments, at least one compound exhibitingthrombopoietic activity is administered, along with at least one othercompound that stimulates bone growth such as BMP-2. In some embodiments,the compounds are administered along with at least one additionalcompound such as an antibiotic, bone filler, glue, or the like.

Levels of compounds that exhibit thrombopoietic activity such asrecombinant TPO that are required or desirable for promoting bone growthand healing will vary from patient to patient depending on factors suchas the size of the patient, age, gender, general health and the type andextent of the disease, defect or injury being treated. In mice, anamount of recombinant TPO on the order of about 1.0 μg is sufficient topromote bone healing while about 10 μg of recombinant TPO exhibitedbetter results in rats. Determining the correct dosage for patients,including human patients, required for effective treatment is wellwithin the skill of those of ordinary skill in the medical arts andcertainly will not require undue experimentation.

In some embodiments, methods that include contacting bone with anexogenous source of a compound exhibiting thrombopoietic activity occurseither in vivo or in vitro. In some embodiments of the invention,compounds having thrombopoietic activity are administered at the sametime that a bone defect, disease or injury is being treated and thecompound is not placed in direct contact with the bone.

In some embodiments, the compound exhibiting thrombopoietic activity isincluded in at least one formulation selected from the group consistingof; a paste, a glue, a coating, a gel, a powder and a liquid.

Some embodiments of the invention include devices for treating bonedefects, comprising: at least one physical support and at least onefirst compound that exhibits thrombopoietic activity. In some of theseembodiments, the device is biodegradable and in some embodiments, thedevice is the form of a scaffold that can be used to stabilize, holdfast or support a bone. In some embodiments, the compounds that exhibitsthrombopoietic activity is recombinant TPO and/or romiplostim and/or aromiplostim like molecule and/or megakaryocyte growth and developmentfactor (MGDF) and/or a compound that acts like MGDF. In someembodiments, the compounds exhibiting thrombopoietic activity can beinjected directly or, at least, near to a bone or to a portion of a bonebeing treated. In some embodiments, the carrier for the compoundexhibiting thrombopoietic activity formulated for use in bone healing isin the form of a gel, suspension, paste, glue, powder and the like. Itmay also be administered as a patch, disc, or implant. It may also beapplied to the surface of an object that comes into direct or indirectcontact with at least a portion of a bone. Such objects include, but arenot limited to, screws, pegs, posts, staples, nails, wires, springs,braces levers and the like. Formulations and objects that includecompounds having exhibiting thrombopoietic activity may also be used topromote bone growth and/or healing in dental applications.

Some embodiments of the invention include methods for treating bonedefects, diseases or injuries, comprising the steps of: identifying abone defect; providing a biodegradable device, wherein said deviceincludes at least one compound that exhibits thrombopoietic activity;and contacting said biodegradable device with the bone defect. In someembodiments, the device is biodegradable; for example, a biodegradablescaffold. In some embodiments, the treated bone is a mammalian bone; forexample, a human, mouse or rat bone. In some embodiments, the devicefurther includes at least means for anchoring the device such as a pin,screw, staple, brace, clamp or the like.

Some aspects of the invention include devices for treating bone defects,comprising: at least one physical support and at least one source ofTPO. In some embodiments, the scaffolding is biodegradable. In someembodiments, a compound having thrombopoietic activity is directlyplaced near or in contact with a portion of bone or near a portion ofbone. Methods for directly delivering compound having thrombopoieticactivity in vivo include injections and/or surgical interventions.

Still other embodiments include methods of treating a bone defect,comprising the steps of: identifying a bone defect; providing abiodegradable device, wherein said device includes TPO; and contactingsaid biodegradable device with the bone defect. In some embodiments, thescaffolding is biodegradable. In some embodiments, the bone defect is ina human or animal patient. In some embodiments, the scaffolding mayinclude at least one additional bioactive compound such as an additionalgrowth factor and/or a compound that inhibits infection. In someembodiments, the scaffolding includes at least one device or feature toattaching the scaffolding to patient's bone.

SEQUENCE LISTING

SEQ. ID NO. 1. Recombinant mouse thrombopoietin (TPO).

SEQ. ID NO. 2 Recombinant human thrombopoietin (TPO).

SEQ. ID NO. 3 Recombinant rat thrombopoietin (TPO).

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1A. Histological assessment of C57BL/6 long bones. Toluidine bluestained proximal tibiae from 9-month-old C57BL/6 control mice. C57BL/6tibiae show the typical trabecular and cortical bone volume just abovethe growth plate and otherwise unremarkable histology seen in older mice(50× original magnification).

FIG. 1B. Toluidine blue stained proximal tibiae from 9-month-old GATA-1deficient mice. GATA-1 deficient tibiae illustrate the striking increasein trabecular and cortical bone (50× original magnification).

FIG. 1C. μCT analysis of femurs from 5-month-old C57BL/6 mice. C57BL/6femurs are normal in appearance with respect to the medullary canal,secondary spongiosa, and mid-diaphyseal cortical bone.

FIG. 1D. μCT analysis of femurs from 5-month-old GATA-1 deficient mice.GATA-1 deficient femurs show cortical thickening, increased trabecularbone volume in the entire medullary canal, including bone filling theproximal metaphysis and part of the diaphyseal shaft.

FIG. 2. Bar graph showing C57BL/6 bone marrow macrophages (BMMs) werecultured with M-CSF (30 ng/ml) and RANKL (50 ng/ml). While culturingC57BL/6 BMMs with M-CSF and RANKL (no TPO) results in the generation ofmature TRAP⁺ multinucleated osteoclasts (OCs) (>3 nuclei), culturingthese cells with TPO (0.1-100 ng/ml) enhances the number OCs by>2-fold.*p<0.05

FIG. 3A. Representative micrograph of cultures of BMMs stimulated withM-CSF (30 ng/ml) and RANKL (50 ng/ml). TRAP staining shows mature,multinucleated OCs developed in the absence of TPO.

FIG. 3B. Representative micrograph of cultures of BMMs stimulated withM-CSF (30 ng/ml) and RANKL (50 ng/ml). TRAP staining shows mature,multinucleated OCs developed in the presence of TPO (100 ng/ml).Significantly more OCs developed with TPO stimulation.

FIG. 4A. 129/Sv (control mice) spleen cells were transferred intoirradiated 129/Sv-recipient mice. Toluidine blue staining of tibiae, 8weeks following adoptive transfer shows bones similar to 129/Sv controlmice.

FIG. 4B. NF-E2^(−/−) spleen cells were transferred into irradiated129/Sv-recipient mice. The NF-E2^(−/−) bone phenotype was successfullytransferred. Histomorphometric measurements showed that trabecular bonevolume was similar to that seen in NF-E2^(−/−) mice.

FIG. 5. μCT images of mouse and rat femurs 15 weeks post-surgery, withcontrol (untreated) scaffolds or scaffolds containing BMP-2 (4 μg and 10μg, respectively) or TPO (1 μg and 10 μg, respectively). # indicates thescaffold.

FIG. 6. X-ray images of gaps in the femurs of male mice over time havingundergone three different treatments: control (left panel), BMP-2 (4 μg,middle panel), and TPO (1 μg, right panel). Images were taken 2, 4 and 6weeks after surgery. Periosteal bridging evident in 4 vs. 6 wks infemurs with TPO-treated scaffolds.

FIG. 7A. Photomicrograph of rat femur defect treated with BMP-2 (10 μg).S—denotes scaffold.

FIG. 7B. Photomicrograph of rat femur defect treated with TPO (10 μg).S—denotes scaffold.

FIG. 8. Cartoon depicting a model of the scaffold and thromopoietin inbone healing consistent with the results disclosed herein.

FIG. 9. Depiction of a scaffold that includes bone cement such as DCDPwhich can be used to deliver compounds such as TPO.

FIG. 10. Dimensions of a representative mouse femoral defect scaffold.

DESCRIPTION

For the purposes of promoting an understanding of the principles of thenovel technology, reference will now be made to the preferredembodiments thereof, and specific language will be used to describe thesame. It will nevertheless be understood that no limitation of the scopeof the novel technology is thereby intended, such alterations,modifications, and further applications of the principles of the noveltechnology being contemplated as would normally occur to one skilled inthe art to which the novel technology relates are within the scope ofthe claimed invention.

Despite advances in surgical technique and implants, orthopaedicsurgeons are still challenged to obtain fracture union, spine fusion, orbridging of segmental defects. The gold standard for grafting to achievebone union/fusion is the use of donor bone (autograft) from thepatient's hip. Even autografting is sometimes not sufficient to achievehealing, exacerbated by the fact that the harvest of bone from apatient's hip often leaves a patient with a very painful donor site,which may not resolve. For this reason, orthopaedic surgeons desire abiologic enhancement for bone healing that does not require theharvesting of a patient's iliac crest hip bone. Other than autograft,bone morphogenetic proteins (BMPs) are currently the only other biologicoption shown to be capable of bridging critical sized bone defects.Although BMP's are potent in promoting bone regeneration, they can leadto heterotopic bone formation which may require additional surgery, andthey are also expensive. Therefore, researchers are constantly seekingnew candidate molecules that can provide equivalent or better treatmentresults.

In order to overcome the limitations in current orthopaedic practice,researchers are exploring tissue engineering. One approach involvescombining biodegradable scaffolds with bone growth inducing factors suchas bone morphogenetic proteins (BMP) and demineralized bone matrix.Using this technique some missing bone tissue in segmental defects ornonunions can be healed. BMP-2 is a potent stimulator of boneregeneration. Unfortunately, the use of BMP-2 may lead to heterotopicbone formation that may require additional surgery. Still anotherdownside to using BMP-2 is it's expensive. Due to the relatively highcost of BMP and inconsistent results from demineralized bone matrix,researchers are constantly seeking new molecules and methods that canprovide equivalent or better treatment results than the existingtreatment for segmented bone loss. Although a number of growth factors(TGF-β, FGF, IGF, PDGF) have been shown to promote bone healing, priorto this work none, other than BMP's, have been shown to be capable ofhealing a critical sized defect. Data disclosed herein demonstrates thatnot only can thrombopoietin (TPO, the main megakaryoctye growth factor)heal a critical sized defect, but it appears to do so more robustly thandoes BMP-2. As detailed below, the trabeculae are thicker and the callusappears to have undergone more extensive remodeling and/or lessheterotopic bone formation in defects treated with TPO than bone defectstreated with BMP-2.

To overcome the disadvantages of donor site morbidity while maintainingthe biologic attractiveness of autograft, tissue engineering is nowbeing explored. The tissue engineering approach uses a biodegradablescaffold which can deliver the biological factors and/or cells to thedefect site and can provide a temporal attachment for the forming of newtissues. After the new tissue forms, the carrier will degrade and beresorbed by tissue, leaving no artifact behind. Current optionsavailable to treat segmental defects include autologous bone graft,allograft, and distraction osteogenesis. Each option is associated withpossible significant morbidity. To overcome these limitations, tissueengineering has been a major focus of recent research. Currently, FDAapproved growth factors shown to improve healing in segmental defectsare BMP-2 and 7. However, BMPs also have significant limitations, suchas cost and method of delivery in a segmental defect.

Recently, a high strength biodegradable scaffold used it to carry bonemorphogenetic protein-2 (BMP-2) was reported. In this report a rat femurmodel was used to demonstrate significant bone formation in experimentalgroups. The results showed that the scaffold is sufficient to sustainload in the segmental defect and also can successfully release BMP-2 tofacilitate healing [19].

Unfortunately, the use of BMP-2 in humans can be cost-prohibitive. Dueto the relative high cost of BMP, researchers are constantly seeking newcandidate molecules that can provide equivalent or better treatmentresults in place of BMP or demineralized bone matrix.

It has also been demonstrated that megakaryocytes (MKs) enhanceosteoblast proliferation by 3- to 6-fold and increase bone formation invivo [18, 20]. As reported herein, coating scaffolds that includemegakaryocyte growth factor, such as TPO, enhance bone regeneration.

It appears that with TPO-coated scaffolds more extensive remodelingand/or less heterotopic bone formation has occurred than that observedwith BMP-2. Importantly, these studies demonstrate that osteoclastprogenitors express the TPO receptor and that treatment of these cellswith TPO increases osteoclastogenesis by up to 5-fold [4]. These resultsshow that the here-to-fore previously unrecognized role of TPO inosteoclastogenesis is critically important in the enhanced bone healingseen with TPO coated scaffolds as it appears to lead to acceleratecoupling/remodelling and therefore accelerated bone healing.

Studies demonstrate that 1) Mice with increased numbers of bonemarrow-derived MKs have up to a 300% increase in bone volume; and 2) MKsenhance OB proliferation up to 6-fold in vitro and 2-3 fold in vivo.Additional data demonstrates that OC progenitors express the TPOreceptor, c-mpl, and that stimulation of OC progenitors with TPO resultsin an increase in mature OC formation in vitro (up to 5-fold). [4].

Mouse models where transcription factors that are thought to benecessary for normal MK differentiation were either markedly reduced orknocked-out, GATA-1 and NF-E2, respectively are known. As shown in FIG.1, these mice develop a marked increase in bone marrow MK number with aconcomitant reduction in platelet number and a dramatic increase intrabecular bone [1, 29, 30]. Of interest, mice that overexpress TPO alsohave a 4-fold increase in bone marrow MK number and develop anosteosclerotic bone phenotype with increased bone mineral density[31-35]. Thus, there are currently 3 known mouse models with increasedbone marrow megakaryopoiesis, which results in significant increases inbone volume due to increases in bone formation.

Notably, a novel mouse model of platelet-type von Willenbrand disease(Pt-vWD), with a platelet phenotype identical to the human form of thedisease, showed a marked increase in splenic MK with splenomegaly and ahigh bone mass phenotype with decreased serum measures of boneresorption [36]. In comparison, the TPO overexpressing mice and thetranscription factor deficient mice (GATA-1 and NF-E2) show asignificantly elevated number of bone marrow and splenic MKs. Data fromSuva et al. [36] suggest that increases in splenic MK number results ina marked decrease in bone resorption which in turn results in a highbone mass phenotype. Conversely, when bone marrow MK number is elevated,anabolic bone formation is increased, which also leads to a high bonemass phenotype [1, 29, 30]. Therefore, these mouse models suggest thatin order for anabolic bone formation to occur, MKs must be present inthe bone marrow where they can be in direct contact with OBs.

It should be noted that Perry et. al. (2007) recently examined the c-mpldeficient mice predicting that due to the ˜90% reduction in bone marrowMKs that bone volume would be reduced compared to control mice, where infact they reported no difference [37]. We are in the process ofconfirming these data and extending them with careful analysis of OBnumber and bone formation as well as OC assessment. But, inunderstanding the bone mass in these mice, it is important to note thatthese mice have been documented as having a significant reduction inmyeloid lineage cells [38], possibly owing to the importance of c-mpl onhematopoietic stem cells as well as our novel observation regardingc-mpl expression on OC progenitors [4]. With regard to c-mpl expressionon OCs, we found that OC progentiors express c-mpl (mRNA expression byreal-time PCR as well as protein expression by Western blot andimmunohistochemistry) and that stimulation of osteoclast progenitorsresults in up to a 5-fold increase in formation of mature OCs in vitro.FIGS. 2 and 3 illustrate these data. Therefore, the bone volume observedin c-mpl deficient mice may be similar to control levels due to areduction in bone turnover as well as a reduction in formation.

Additional evidence for the stimulation of OB proliferation and boneformation by MKs comes from in vivo adoptive transfer and irradiationstudies. To better understand the mechanism of increased bone formationin NF-E2^(−/−) mice, we adoptively transferred the MK/bone phenotypeinto lethally irradiated 129/Sv-recipient mice using spleen cells [2].Because the marrow cavity was filled with bone, spleen cells rather thanbone marrow cells were used for the adoptive transfer. Spleen cells arean excellent source of immature MKs (up to 5 fold-increase) andhematopoietic progenitor cells due to the extra-medullary hematopoiesis.Transfer of the NF-E2^(−/−) phenotype to recipient mice was assessed at4 and 8 weeks after transfer by measuring platelet numbers (50-150 inmutant animals and >1000 in controls), spleen weight. At sacrifice (4 or8 weeks after transfer), tibias were processed for histology andhistomorphometry. Mice injected with NF-E2^(−/−) spleen cells developeda phenotype indistinguishable from that of NF-E2^(−/−) mice (FIG. 4).Mice sacrificed 4 weeks after injection with NF-E2^(−/−) cells had anaverage bone volume/tissue volume (BV/TV) of 35% compared to 18% seen inmice injected with +/+ cells (approx. 2-fold increase in bone volume).Similarly, mice sacrificed at 8 weeks averaged 38% BV/TV. The bonevolumes in adoptively transferred mice were similar to, and notsignificantly different from, the 35% bone volumes seen in 5-month-oldmutant animals (the same age as animals sacrificed at 8 weeks). Overall,these adoptive transfer studies suggest that MKs increase OB number andbone formation in vivo. Finally, in recent studies by Dominici et al.[39], in mice treated with lethal total body irradiation, surviving MKswere shown to migrate to endosteal bone surfaces (in close contact withOBs) and stimulate a 2-fold increase in OB number.

Referring now to FIG. 5, A pilot study (n=3) shows that TPO robustlyhealed a critical size defect in rat femur, more so than that observedwith BMP-2. In addition, the trabeculae are thicker and the callus hasundergone more remodeling than that observed with BMP-2.

While it is thought that BMP-2 works by activating osteoblasts,successful fracture repair requires remodelling and thus requireselevated osteoclast activity as well. Therefore, isolated increases inosteoblastic activity without up-regulation of osteoclastic remodellingmay increase the incidence of heterotopic bone which has been reportedas a complication with BMP treatment [10]. As shown in FIG. 5, itappears that at 15 weeks post-operative the TPO specimen has undergonemore extensive remodelling than that observed with BMP-2. Of importance,these in vitro studies demonstrate that osteoclast progenitors expressthe TPO receptor and that treatment of these cells with TPO increasesosteoclastogenesis by up to 5-fold (FIG. 2) [11], which may explain moreextensive remodelling. A critical sized femoral defect was created inthe right femur of ten-week old C57BL/6 male mice. Our scaffold wasinserted into the defect site. There were 3 groups: untreated controls(n=7), TPO treated scaffolds (1 μg, n=8), and BMP-2 treated scaffolds (4μm, n=5). X-rays of femurs 2 and 4 weeks postoperatively demonstratebridging callus formation by 2 weeks in mice with scaffolds containingBMP-2, whereas controls remain unbridged even at 6 weekspostoperatively, confirming that the scaffold has sufficientbiomechanical properties to maintain the segmental defect size. At 2weeks, scaffolds containing TPO remain unbridged; however, at 4-6 weeks,the scaffolds containing TPO have bridged. Of importance, when comparingthe 4-6 week TPO and BMP-2 scaffolds, it appears that TPO betterrestores the original contour of the bone which is advantageous in theclinical setting.

Referring to FIG. 6, it appears that in the TPO specimens more extensiveremodeling has occurred than that observed with BMP-2. Whilehistological analyses are needed to confirm increases in osteoclasticactivity, our preliminary in vitro studies demonstrate that osteoclastprogenitors express the TPO receptor and that treatment of these cellswith TPO increases osteoclastogenesis by up to 5-fold. It appears asthough TPO offers an advantage over BMP-2 in terms of bone remodeling byincreasing both osteoblasts and osteoclasts production, and it maycontribute to improved/faster fracture remodeling and less heterotopicbone formation. As shown in FIG. 6, x-rays of mouse femurs taken 2, 4,and 6 week post-surgery with control (untreated) scaffolds or scaffoldsthat included BMP-2 (4 μg) or TPO (1 μg).

Referring now to FIG. 8, a simplified model of the role of TPO in bonehealing. TPO released at the bone defect site binds to MKs to inducemegakaryopoiesis consistent with the results present herein. Increasednumbers of MKs are then available to influence OB proliferation bydirect cell-to-cell contact. These OBs then form new bone. TPO at thebone defect site also binds to OC progenitors which enhancesosteoclastogenesis, allowing for enhanced remodeling and lessheterotopic bone formation.

TPO and megakaryocyte growth and development factor (MGDF) are thoughtto act by binding to the TPO receptor, c-MP1, on the surfaces of certaincells. The receptor c-MP1 belongs to the class I cytokine receptorfamily. Activation of the receptors in this class is thought to involveligand-binding which induces receptor homodimerization which theninitiates a cascade of signal transducing events. In addition to TPO,other compounds that have TPO like activity and presumably bind to thesame receptor as TPO can be used to stimulate bone growth. Compoundswith TPO like activity include those disclosed in U.S. Pat. Nos.6,835,809B1 issued on Dec. 28, 2004 and 7,332,474 B2 issued on Feb. 19,2008, each of which is herein incorporated by reference in its entiretyas if each were incorporated individually in its entirety.

Compounds with TPO like activity include compounds that bind to andelicit a trans-membrane signal by activating the c-MP1 receptor. Thesecompounds can be said to exhibit thrombopoietic activity.

An indirect casting approach previously described by Chu et al.Biomaterials 28:459-467, 2007 was used for scaffold fabrication. Foradditional information on related techniques, please see WO/2006-088866,which is incorporated herein by reference in its entirety. As previouslyreported, successful manufactured load-bearing tissue engineeringscaffolds have been created and successfully used to induce boneregeneration in critical-sized segmental defects in rat femurs.Tube-shaped scaffolds were manufactured from poly(propylene)fumarate/tricalcium phosphate (PPF/TCP) composites.

A biodegradable, load-bearing carrier for delivery of material thatexhibits thrombopoietic activity can be illustratively made from highstrength biodegradable composites. When first implanted, the carrierprovides an initial biomechanically stable environment for boneformation across the interface between bone and carrier. The osteogeniccompound-carrying biodegradable carrier may provide an osteoinductiveenvironment to attract stem cells and progenitor cells to migrate to,populate, and mineralize on the carrier surface, illustratively to forma continuous bridge between the proximal and distal segments of thebone. Finally, the degradable carrier can degrade allowing the bone tofill in the space left by carrier. The bone may then continue to remodelto physiological geometry and mechanical properties.

As used herein, the term “carrier” or “structural carrier” refers tothis high strength structural carrier to be used in conjunction with anosteogenic compound such as DBM. The DBM may be supplied in a moleculecarrier (i.e. hyaluronic acid, glycerol, calcium sulfate hemihydrate,etc.). When referring to such molecule carrier, the term “moleculecarrier” is used. While many of the examples use DBM, it is understoodthat other materials that provide for an osteoinductive environment maybe used as well. Such materials include, but are not limited to, bonemorphogenic protein (BMP) (including bone morphogenetic protein-2, bonemorphogenetic protein-4, and bone morphogenetic protein-7), tissuegrowth factor beta (TGF-β), platelet-derived growth factor (PDGF),fibroblast growth factor (FGF), insulin-like growth factor (IGF), andvascular endothelial growth factor (VEGF). Moreover, the substancescarried by the structural carrier are not limited to proteins. Thestructural carrier can include antibiotics or anti-inflammatory drugs.Suitable antibiotics include, but are not limited to, benzylpenicillin,cefazolin, clindamycin, vancomycin, nafcillin, and ciprofloxacin. Thestructural carrier can also include other substances to promote anosteoinductive environment including cells.

The use of DBM, BMP, or other osteogenic compounds in treating segmentaldefects may be combined with a high strength, load-bearing, andbiodegradable carrier. When first implanted, the load-bearing carrierprovides an initial biomechanically stable environment for boneformation across the bone scaffold junction. The compound havingthrombopoietic activity released from the biodegradable carrier thenprovides an environment that stimulates bone growth and development aswell as mineralization on the scaffold surface, illustratively to form acontinuous bridge between the proximal and distal segments of the bone.Finally, the degradable carrier does degrade and, in time, allows thepatient's own bone to fill in the space left by carrier and continue toremodel to the physiological geometry and mechanical properties.

Healing gaps larger than the critical bone gap in animals is difficult.Fortunately, the use of mechanical structures, strategically placedwithin the gap has helped to treat these types of bone gaps in manymammals. In some of the approaches that have worked, the mechanicalstructure placed in the gap is positioned so as to bear weight whileallowing for bone regeneration. This achievement has rarely, if ever,been performed in the long bones of mice in the presence of growthfactors alone (e.g. without the addition of cells). The exact reason forthis is not known. Without being bound by any theory, hypothesis orexplanation it may be that something unique to mouse physiologycomplicates or otherwise disfavours closing these sized gaps in mice.Still another possibility is the ratio of the defect length-to-bonelength. Indeed, in the mouse a 4 mm segmental defect is required (tocreate a “critical sized defect” whereby the defect cannot heal on itsown) and the length of mature mouse femurs is ˜10-12 mm, resulting inapproximately a 1:3 ratio. While, in a rat which is a much larger animala 5 mm segmental defect is sufficient to create a critical sized defectand as a rat femur is ˜40 mm, this results in approximate 1:8 ratio ofgap to over all bone length. Similarly, the cross sectional area of arat's femur is significantly larger than the cross sectional area of amouse's femur. The greater cross sectional area of the bone segmentsbracketing the critical sized defect imply that there are more marginsfor error when contacting a scaffold or other inset in the bone gap in arat than there is performing a similar procedure in a mouse. Due in partto its higher gap to bone length ratio and the greater cross sectionalarea of the rat femur, an implant in a rat's bone gap is inherently morestable then is an implant in a corresponding gap in a mouse femur.Accordingly, it is possible that the additional stability in the rat dueto the increased support on each end of the femur allows for moreflexibility in the scaffold design and surgical precisions. Whereas withthe reduced support and stability in the mouse femur, the precision ofscaffold design, scaffold structure position, and surgical technique isof heightened importance to promote bone gap closure. Near ideallypositioning of a scaffold within a bone gap requires a scaffoldengineered to almost perfectly fit into the bone gap. A less thanoptimal alignment of the scaffold, due perhaps to imperfections in thescaffold itself and the flanking bone tissue, may result in movement ofthe scaffold and possible scaffold fracturing which will not allowadequate bone regeneration to close critical bone gaps in mice.

Thus, one aspect of the present invention provides an implant scaffoldfor facilitating bone healing in a mouse. In some embodiments, theimplant includes at least one compound that exhibits thrombopoieticactivity and a structural carrier formed from a biodegradable material,the structural carrier comprising a body and having at least one recesstherein. In some embodiments, the scaffold may also include at least oneadditional material that has osteogenic activity, including, but notlimited to, materials selected from the group consisting ofdemineralized bone matrix and bone morphogenic protein; the body of thescaffold may form generally cylindrical shape. The scaffold body mayfurther define a plurality of additional recesses; at least one of theadditional recesses may be sized to receive a screw for plate fixation.In some embodiments, a second osteogenic material may be provided in oneof the additional recesses, optionally wherein the osteogenic materialand the second osteogenic material are different. In some embodiments,the compounds having thrombopoietic activity, such as TPO, may beprovided in a first time release material having a first time releaseprofile while a second osteogenic material is provided in a second timerelease material having a second different time release profile. In someembodiments, the second osteogenic material is VEGF and the secondosteogenic material is BMP. In some embodiments, the first time releaseprofile may have a faster time release profile than the second timerelease profile. In some embodiments, at least one of the recesses mayinclude an antibiotic; the compound having thrombopoietic activity, andthe osteogenic material may be absorbed into an amount of dicalciumphosphate dihydrate (DCPD) cement that has been provided in the recess,the structural carrier may possess sufficient mechanical strength to beload bearing; and the biodegradable material may be poly(caprolacton)trimethacrylate/tricalcium phosphate (“PCLTMA/TCP”).

Still other aspect of the invention, an implant for facilitating bonehealing in mice comprising at least one compound that exhibitsthrombopoietic activity, and a structural carrier formed from abiodegradable material, the structural carrier comprising a wallextending from a first end to a second end and defining a centralchannel extending from an opening in the first end to an opening in thesecond end. In some embodiments, the longitudinal center of the scaffoldor other implant is hollow and can be used to accommodate at least onerod that is parallel to the length of the implant and extends beyond thefirst and second distal ends of the implant in to the first and secondbone fragments that bracket the critical sized gap in the bone. Withinthe tubular wall channel(s) or port(s) may form a generally cylindrical,elliptical, or tapered elliptical shape and the osteogenic material maybe placed within at least one of the channels. In some embodiments, thebody of the scaffold or other implant includes a plurality of windowsextending from the exterior side wall of the implant towards thelongitudinal center of implant. Optionally, the compound exhibitingthrombopoietic activity is provided in one of the windows and a secondosteogenic material is provided in another of the windows. In someembodiments, at least one of the windows in the device include anantibiotic; bone growth promoting factor such as TPO may be absorbedinto an amount of dicalcium phosphate dihydrate (DCPD) cement that hasbeen provided in one of the windows. The structural carrier may possesssufficient mechanical strength to be load bearing; and the biodegradablematerial may be PCLTMA/TCP. In some embodiments, the osteogenic materialmay be selected from the group consisting of demineralized bone matrixand bone morphogenic protein may also be added to the device.

Still other aspects of the invention include methods for repairing bonedefects in mammals. Some of these methods may comprise the steps ofplacing a structural implant comprising a compound having thrombopoieticactivity into the defect site and fixing the implant to surrounding bonetissue. Some of the methods may optionally include the step of leavingthe implant in place and allowing the implant to degrade. Optionally,the fixing step may comprise using an intramedullary pin or may compriseusing a plate and at least one screw.

Experimental Materials and Methods

A pilot study utilizing the Long Evans rat femur gap model [9] which hasbeen approved by the Laboratory Animal Care and Usage Committee (IACUC)at Indiana University was used to test a new method for repairing bonegaps. In brief, tube shape scaffolds with 4 mm external diameter, 2 mminternal diameter and 5 mm in height were manufactured frompoly(propylene) fumarate/tricalcium phosphate. 10 μg of TPO or 10 μg ofBMP-2 were introduced into the dicalcium phosphate dehydrate cementregion of the scaffolds. In the control group, the scaffolds were leftuntreated (n=3/group). Segmental defects of 5 mm were created in theright femurs of male Long Evans rats. The defect was filled with a 5 mmscaffold and secured with an intramedullary K-wire placed in retrogradefashion. Femurs were imaged by x-ray to assure proper placement andintegrity of the scaffold. The rats were then imaged using x-ray atthree week intervals to assess continued healing. At post-operativeweeks 6 and 15, rats were euthanized and femurs analyzed by x-ray,microCT, and histology.

Using microCT analysis, at post-operative week 6, none of the rat femursshowed bridging of the callus. However, at week 15, TPO robustly healeda critical sized defect in the rat femur. The cortex and trabeculae ofthe callus are thicker compared to the callus induced by BMP-2 in anearlier study (FIG. 5). In histological analyses, normal bone marrow wasobserved in the bone marrow cavity without signs of inflammatoryreaction to the scaffolds at both 6 and 15 weeks. At 6 weeks, isolatedbone nodules were observed in the tissues between the two bone ends,indicating the initiation of mineralization of the tissue in the gap. At15 weeks, mineralized callus was seen bridging the two bone ends. Insome areas adjacent to the scaffolds, isolated patches of cartilage withhypertrophic chondrocytes were observed, indicating the tissues wereundergoing endochondral bone formation.

Referring now to FIG. 6. A critical sized femoral defect was created inthe right femur of ten week old C57BL/6 male mice. A scaffold wasinserted into the defect site. There were 3 groups untreated controls(n=7), TPO treated scaffolds (1 μg, n=8), and BMP-2 treated scaffolds (4μg, n=5). X-rays of femurs 2, 4, and 6 weeks postoperatively demonstratebridging callus formation by 2 weeks in mice with scaffolds containingBMP-2; whereas, controls remain unbridged even at 6 weekspostoperatively, confirming that the scaffold has sufficientbiomechanical properties to maintain the segmental defect size. At 2weeks, scaffolds containing TPO remain unbridged; however, at 4-6 weeksthe scaffolds containing TPO have bridged. Of importance, when comparingthe 4-6 week TPO and BMP-2 scaffolds, it appears that TPO betterrestores the original contour of the bone which is advantageous in theclinical setting.

While the novel technology has been illustrated and described in detailin the figures and foregoing description, the same is to be consideredas illustrative and not restrictive in character. It being understoodthat only the preferred embodiments have been shown and described andthat all changes and modifications that come within the spirit of thenovel technology are desired to be protected. As well, while the noveltechnology was illustrated using specific examples, theoreticalarguments, accounts, and illustrations, these illustrations and theaccompanying discussion should by no means be interpreted as limitingthe technology. All patents, patent applications, and references totexts, scientific treatises, publications, and the like referenced inthis application are incorporated herein by reference in their entirety.

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We claim:
 1. A method for treating bone comprising the steps of:treating at least one portion of a living bone with at least oneexogenous compound that exhibits thrombopoietic activity.
 2. The methodaccording to claim 1, wherein the compound that exhibits thrombopoieticactivity is TPO.
 3. The method according to claim 1, wherein thecompound that exhibits thrombopoietic activity is romiplostim or aromiplostim like compound.
 4. The method according to claim 1, whereinthe first compound that exhibits thrombopoietic activity ismegakaryocyte growth and development factor.
 5. The method according toclaim 1, further including the step of: providing at least one secondcompound that is useful for the treatment of living bone.
 7. The methodaccording to claim 1, wherein the contacting step occurs in vivo.
 8. Themethod according to claim 1, wherein the contacting step occurs invitro.
 9. The method according to claim 1, wherein exhibitsthrombopoietic activity is included in at least one formulation selectedfrom the group consisting of; a paste, a glue, a coating, a gel, apowder and a liquid.
 10. A device for treating bone defects, comprising:at least one physical support and at least one compound that exhibitsthrombopoietic activity.
 11. The device according to claim 10, whereinthe device is biodegradable.
 12. The device according to claim 10,wherein the device is a scaffold.
 13. The device according to claim 10,wherein the first compound is TPO.
 14. The method according to claim 10,wherein the first compound is romiplostim.
 15. The method according toclaim 10, wherein the first compound is megakaryocyte growth anddevelopment factor.
 16. The method according to claim 10, wherein thecompound exhibiting is included in at least one formulation selectedfrom the group consisting of; a paste, a glue, a coating, a gel, apowder and a liquid.
 17. A method of treating a bone defect, comprisingthe steps of: identifying a bone defect; providing a biodegradabledevice, wherein said device includes at least one compound that exhibitsthrombopoietic activity; and contacting said biodegradable device withthe bone defect.
 18. The method according to claim 17, wherein saidbiodegradable device is a scaffold.
 19. The method according to claim17, wherein the bone defect is in an animal.
 20. The method according toclaim 17, wherein the bone defect is in human.
 21. The method accordingto claim 17, wherein the device includes at least one additionalcompound that promotes bone growth.
 22. The method according to claim17, wherein the device includes at least one additional compound thatinhibits infection.
 23. The method according to claim 17, wherein thedevice includes at least one anchor for attaching the device to thebone.